Complications and clinical outcomes with minimally invasive plate osteosynthesis (MIPO) technique for midshaft clavicle fractures: a systematic review and meta-analysis.

Background: Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures. Methods: We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality. Results: A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference -12.95, 95% confidence interval [-25.27 to -0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies. Conclusion: The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC.

OBJECTIVE: To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). METHOD: Twenty-seven patients aged 18-59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. RESULTS: Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. CONCLUSION: The clinical and functional results do not present statistically significant differences for both analyzed methods.

OBJETIVOS: Comparar os resultados clínicos e funcionais dos pacientes com diagnóstico de Scaphoid Non Union Advanced Colapse (SNAC), no estágio II, submetidos à ressecção da fileira proximal do carpo ou à artrodese dos quatro cantos. MÉTODO: Foram incluídos no estudo 27 pacientes, com média de 37,52 anos (18-59). Treze foram submetidos à carpectomia proximal no Grupo A e 14 à artrodese dos quatro cantos no Grupo B. O seguimento médio foi de 45 a 73 meses. Foram avaliados os arcos de movimento, a dor, a força de preensão palmar, o Disability Arm Shoulder Hand (DASH) escore e o retorno ao trabalho. RESULTADOS: No Grupo A os pacientes apresentaram 68,5% do arco de movimento no lado não afetado e no Grupo B, 58,01%. Na avaliação subjetiva da dor (VAS), obtivemos 2,3 no Grupo A e 2,9 no Grupo B. A força de preensão palmar foi de 78,67% no Grupo A do lado não acometido e de 65,42% no Grupo B. O DASH escore no Grupo A foi 11 e no Grupo B, 13. Quanto ao trabalho, 69,23% (9/13) dos pacientes no Grupo A e 57,14% (8/14) no Grupo B retornaram a alguma atividade laboral. A taxa de complicações no Grupo A foi de (1/13) e no Grupo B, de 7,1% (1/14). CONCLUSÕES: Os resultados clínico-funcionais estudados não apresentam diferenças estatísticas para os dois métodos analisados.

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC / Ensaio clínico randomizado entre ressecção da fileira proximal (carpectomia) e artrodese dos quatro cantos nos pacientes portadores de SNAC no estágio II

ABSTRACT OBJECTIVE: To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). METHOD: Twenty-seven patients aged 18-59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. RESULTS: Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. CONCLUSION: The clinical and functional results do not present statistically significant differences for both analyzed methods.

RESUMO OBJETIVOS: Comparar os resultados clínicos e funcionais dos pacientes com diagnóstico de Scaphoid Non Union Advanced Colapse (SNAC), no estágio II, submetidos à ressecção da fileira proximal do carpo ou à artrodese dos quatro cantos. MÉTODO: Foram incluídos no estudo 27 pacientes, com média de 37,52 anos (18-59). Treze foram submetidos à carpectomia proximal no Grupo A e 14 à artrodese dos quatro cantos no Grupo B. O seguimento médio foi de 45 a 73 meses. Foram avaliados os arcos de movimento, a dor, a força de preensão palmar, o Disability Arm Shoulder Hand (DASH) escore e o retorno ao trabalho. RESULTADOS: No Grupo A os pacientes apresentaram 68,5% do arco de movimento no lado não afetado e no Grupo B, 58,01%. Na avaliação subjetiva da dor (VAS), obtivemos 2,3 no Grupo A e 2,9 no Grupo B. A força de preensão palmar foi de 78,67% no Grupo A do lado não acometido e de 65,42% no Grupo B. O DASH escore no Grupo A foi 11 e no Grupo B, 13. Quanto ao trabalho, 69,23% (9/13) dos pacientes no Grupo A e 57,14% (8/14) no Grupo B retornaram a alguma atividade laboral. A taxa de complicações no Grupo A foi de (1/13) e no Grupo B, de 7,1% (1/14). CONCLUSÕES: Os resultados clínico-funcionais estudados não apresentam diferenças estatísticas para os dois métodos analisados.

Experience with the ABC Foundation School of Medicine undergraduate meeting.

OBJECTIVE: To quantify the number of studies that were presented during oral sessions, selected for awards and published from 2002 to 2007 at the Undergraduate Medical Congress of ABC at the ABC Foundation School of Medicine. METHODS: A retrospective systematic survey of papers selected for oral presentation and award at these undergraduate meeting from 2002 to 2007 was carried out by searching Medline and Lilacs databases and the annals of other medical meetings in order to ascertain which papers would eventually be published. RESULTS: From 2002 to 2007, 408 papers were selected for oral presentation and 71 (17.4%) received at least one award. The total number of papers published was 138 (33.8%), of which 33 (8.1%) were in Medline, 57 (14%) in Lilacs and 48 (11.7%) in the annals of other scientific meetings. Receiving an award by the scientific committee was an independent variable for publication (OR: 2.05 95% CI 1.22-3.46, p = 0.006) as well as for publication in Medline (OR: 2.62 95% CI 1.21 - 5.69, p = 0.01). CONCLUSION: The institutional scientific production of undergraduate medical students presented in Undergraduate Medical Meetings is relevant and should continue to be stimulated.

Experience with The ABC Foundation School of Medicine Undergraduate Meeting / Experiência do Congresso Médico Universitário da Faculdade de Medicina da Fundação ABC

OBJECTIVE: To quantify the number of studies that were presented during oral sessions, selected for awards and published from 2002 to 2007 at the Undergraduate Medical Congress of ABC at the ABC Foundation School of Medicine. METHODS: A retrospective systematic survey of papers selected for oral presentation and award at these undergraduate meeting from 2002 to 2007 was carried out by searching Medline and Lilacs databases and the annals of other medical meetings in order to ascertain which papers would eventually be published. RESULTS: From 2002 to 2007, 408 papers were selected for oral presentation and 71 (17.4 percent) received at least one award. The total number of papers published was 138 (33.8 percent), of which 33 (8.1 percent) were in Medline, 57 (14 percent) in Lilacs and 48 (11.7 percent) in the annals of other scientific meetings. Receiving an award by the scientific committee was an independent variable for publication (OR: 2.05 95 percent CI 1.22-3.46, p = 0.006) as well as for publication in Medline (OR: 2.62 95 percent CI 1.21 - 5.69, p = 0.01). CONCLUSION: The institutional scientific production of undergraduate medical students presented in Undergraduate Medical Meetings is relevant and should continue to be stimulated.

OBJETIVO: Quantificar e descrever o número de trabalhos premiados e não premiados em apresentação oral no Congresso Médico Universitário do ABC no período de 2002 a 2007, que obtiveram posterior publicação em revistas científicas, a fim de avaliar se o trabalho premiado teria maior potencial para publicação. Mapear áreas por produtividade científica na instituição. MÉTODOS: Busca retrospectiva dos trabalhos inscritos no período de 2002 a 2007 que obtiveram publicação em periódicos indexados nas bases de dados Medline (Pubmed) e Lilacs ou em anais de congressos científicos de especialidades nacionais ou internacionais. RESULTADOS: Entre 2002 e 2007, foram inscritos 408 trabalhos e 71 foram premiados. O total de trabalhos publicados foi de 138 (33,8 por cento), sendo 8,1 por cento na base Medline, 14 por cento na base Lilacs e 11,7 por cento encontrados a partir da plataforma Lattes. Premiação pela banca examinadora foi variável independente para publicação (OR: 2,05 IC95 por cento 1,22-3,46; p=0,006) assim como para publicação na base Medline (OR: 2,62 IC95 por cento 1,21- 5,69; p=0,01). CONCLUSÃO: O papel de alunos de graduação na produção científica institucional refletido na produção de um Congresso Médico Universitário é relevante e deve continuar a ser estimulado.